Differential diagnosis of female sexual pain by anatomic location

Superficial (distal)	Deep (proximal)	Other local or regional conditions causing increased pain	Psychosocial factors contributing to increased pain
Decreased serum estrogen
Hormonal contraception Postpartum and/or lactation Genitourinary syndrome of menopause Reduced ovarian function Antiestrogen therapy	Endometriosis Adnexal masses Pelvic inflammatory disease Uterine fibroids (leiomyomas) Myofascial pelvic pain syndrome	Chronic pelvic pain of unknown etiology Vulvar pain of unknown cause (vulvodynia) Myofascial pelvic pain syndrome Interstitial cystitis/bladder pain syndrome Pudendal neuralgia Pelvic congestion syndrome Persistent genital arousal disorder	Intimate partner violence Impact of mental health
Decreased lubrication
Hormonal contraception Decreased physiologic arousal Surgery
Constriction or obstruction of vaginal orifice
Congenital anomalies Pelvic organ prolapse Vaginismus Myofascial pelvic pain syndrome Vulvar dystrophies and dermatoses Postprocedural anatomic change Childbirth Pelvic floor reconstructive surgery Cancer surgery, chemotherapy, or radiation Female genital cutting

Dr. Mallika Anand, MD.

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